Citation
Cooney, Erin E.; Reisner, Sari L.; Saleem, Haneefa T.; Althoff, Keri N.; Beckham, S. Wilson; Radix, Asa; Cannon, Christopher M.; Schneider, Jason S.; Haw, J. S.; & Rodriguez, Allan E., et al. (2022). Prevention-Effective Adherence Trajectories among Transgender Women Indicated for Prep in the United States: A Prospective Cohort Study. Annals of Epidemiology, 70, 23-31. PMCID: PMC9167788Abstract
PURPOSE: Adherence to pre-exposure prophylaxis (PrEP) during periods of PrEP-indication (i.e., prevention-effective adherence) is critical for preventing HIV. We sought to describe factors associated with prevention-effective adherence trajectories among transgender women (TW) to inform PrEP implementation strategies.METHODS: Using data from The LITE American Cohort (n=728), we performed group-based multi-trajectory modeling (GBMTM) to identify clusters of TW with similar trajectories of PrEP adherence and indication, and sociodemographic, biobehavioral, and structural correlates of each trajectory.
RESULTS: We identified five trajectories: 1) consistent indication/no PrEP (15.3%), 2) initial indication/no PrEP (47.1%), 3) declining indication/discontinued PrEP (9.5%), 4) consistent indication/PrEP adherent (18.5%), and 5) increasing indication/initiated PrEP (9.6%). TW diagnosed with an STI were more likely to follow a consistent indication/no PrEP trajectory compared to consistent indication/PrEP adherent trajectory (adjusted Relative Risk Ratio [aRRR]:2.54; 95%CI:1.16-5.57). TW who experienced homelessness were more likely to follow PrEP discontinuation and initiation trajectories relative to PrEP adherence (aRRR:2.71; 95%CI:1.10-6.70 and 2.83; 95%CI:1.13-7.05, respectively).
CONCLUSIONS: Over a quarter of TW followed trajectories suggestive of prevention-effective adherence, while 15% did not initiate PrEP despite consistent indication. Findings highlight missed opportunities for PrEP engagement at STI diagnosis and suggest structural interventions addressing housing instability may improve prevention-effective adherence among TW.
URL
http://dx.doi.org/10.1016/j.annepidem.2022.03.016Reference Type
Journal ArticleYear Published
2022Journal Title
Annals of EpidemiologyAuthor(s)
Cooney, Erin E.Reisner, Sari L.
Saleem, Haneefa T.
Althoff, Keri N.
Beckham, S. Wilson
Radix, Asa
Cannon, Christopher M.
Schneider, Jason S.
Haw, J. S.
Rodriguez, Allan E.
Wawrzyniak, Andrew J.
Poteat, Tonia
Mayer, Kenneth H.
Beyrer, Chris
Wirtz, Andrea L.